Federal Employees' Group Life Insurance Program

Certification of Insured Employee's Retired Status

Use:

Agencies use this form for employees who have (1) retired under any Federal system OTHER THAN the Civil Service Retirement System (CSRS) or Federal Employees' Retirement System (FERS), and who (2) submit a completed SF 2821, Agency Certification of Insurance Status.

Electronic Copies:

• PDF Fillable Version:[316 KB]

To use the Adobe Acrobat forms you need the commercial Acrobat software or the free downloadable Acrobat Reader. You can fill in this form on your computer screen before you print it.

Paper Copies:

Use your internal agency procedures for ordering Standard Forms.

Paper copies of this form are NOT available from OPM.